Do we need 5-FU in addition to cisplatin for chemoradiation of locally advanced head-and-neck cancer?

OBJECTIVES: To compare chemoradiation with cisplatin alone or cisplatin plus 5-FU for locally advanced squamous cell carcinoma of the head-and-neck (SCCHN).

MATERIALS AND METHODS: The outcomes of 142 patients who received chemoradiation with cisplatin alone for locally advanced SCCHN were retrospectively compared to 170 patients who received cisplatin plus 5-fluorouracil (5-FU). The outcomes compared included loco-regional control (LRC), metastases-free survival (MFS), overall survival (OS) and adverse events.

RESULTS: Although patients who received cisplatin alone had a significantly worse performance status, 81% of these patients completed planned chemotherapy compared to 73% of patients in the cisplatin plus 5-FU group (p=0.18). Radiotherapy breaks >1week were necessary in 14% and 23% of patients, respectively (p=0.09). The 5-year LRC rates were 69% after cisplatin alone and 68% after cisplatin plus 5-FU (p=0.71). The 5-year MFS rates were 72% and 62%, respectively (p=0.37), and 5-year OS rates were 60% and 45%, respectively (p=0.066). On multivariate analysis, cisplatin alone was significantly associated with improved OS (RR 1.35; 95%-CI 1.09-1.69; p=0.006). Nausea/vomiting, pneumonia/sepsis and late adverse events occurred more common in the cisplatin plus 5-FU group.

CONCLUSION: Given the limitations of a retrospective study, chemoradiation with cisplatin alone appeared associated with fewer adverse events and better OS than with cisplatin plus 5-FU in patients with locally advanced SCCHN. Thus, 5-FU in addition to cisplatin may be omitted for these patients. A randomized trial is warranted to confirm these findings.